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Normal Stress Incontinence or Injury due to Catheter
Hi,
7 weeks ago I gave birth to my second child, it was a long labour with second stage of over 2 hours, and ended up being a forceps delivery.  I had an epidural and catheter.  Almost immediately afterwards I noticed I had no bladder control.  Still 7 weeks on I have what is being described as severe urinary stress incontinence which happens whenever I move, sit up, walk etc.  My entire bladder can empty.  Nothing has improved.  I later found out that the catheter balloon got 'yanked' and was pulled from my bladder into my urethra.  I am wondering whether what I am experiencing is just stress incontinence, or is the result of this injury due to the catheter being pulled down into the urethra, and now the urethra sphincter no longer working properly due to being stretched?  If it is a case of the latter, will this repair itself?  I am sure it must have happened to people before, I am wanting to know the prognosis.  Is there a surgery to fix this?

I am meeting with a Uro-Gynae in a few weeks to discuss options but in the meantime I am at my wits end trying to look after a newborn and 3 year old while constantly leaking and wetting my pants.  I am happy to have surgery, or may investigate macroplastiques (injections of bulking agents to help narrow the urethra), however I am terrified that there may be no fix to this, if it is in fact an injury due to the catheter.

Can anyone shed any light on this?  Are there other cases of catheters being pulled out of place and the balloon stretching the urethra, and if so, what was the outcome?

Any advice appreciated.
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1128665 tn?1269277071
Hi ejy1979, welcome to the community!

First up, there is hope for improvement/repair. It sounds like there were several things that occurred during this delivery that could have caused some issues. A long labor, a long, intense 2nd stage labor, and forceps delivery can all create pelvic organ prolapse concerns. Add to that the potential for damage from yanking of the cath out too quickly.

You have made the right first step, making an appt with a urogynecologist-this is THE specialist to see with pelvic organ prolapse issues, they are familiar with all of the organs in the pelvic floor region (bladder, rectum/colon, intestines, vagina, urethra, uterus) as well as all of the structural tissues that hold these organs in place. A urogyn will be able to examine and know what tests need to be done to accurately diagnose any and all damage done. Once the damage has been assessed, a path of treatment can be formed, surgical, non-surgical treatment, or combination of both. There are many choices that can be made and your urogyn/physical therapist/NP can guide you through what choices will be the right ones for you. Know that we will be here to help you with questions you have along your treatment path as well.

One thing to make note of, if you do end up needing or choosing surgery, it is imperative that you do NOT lift babies for an extended period of time after surgery; POP surgery is very intricate and it is extremely important to let the tissues heal properly b/4 lifting heavy weight, babies included. Your urogyn will guide you with a time frame (it will depend on what treatments/procedures you choose). After the initial heal curve you'd be able to have someone place the baby in your lap with pilllow protection to abdomen for feeding, and to nuture your baby as well, but lifting heavy babies/objects too soon may undo the surgical repair.

Send your questions as they come to you, we'll address them one at a time and hang in there, there is a light on the horizon.


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Hello-

I am sorry to hear that you have been suffering after the delivery of your second child.  From what you described your body has gone through a good deal of trauma.  I am a myofascial therapists that treats a lot of women with incontinence.  Unfortunately, they are told by many physicians that it is normal after child birth and that it will go away.  I have seen to many woman that have been living with incontinence type issues for years when they don't have too.  

There is a lot that can be done from a non-surgical standpoint and i would recommend that you try every non-invasive procedure first.  I encourage you to have the proper tests done by your MD to clear any other causes, but if they come back negative know that your symptoms may be caused my fascial restrictions in the pelvic and other areas.  I have included a link to an article on myofascial work below.  I could write a book, but it may be easier for you to read the article.  :-)
http://www.myofascialrelease.com/fascia_massage/articles/release_approach_part1.pdf

I am also including a more specific article on incontinence.  Both articles were written by the found of myofascial work (John Barnes).  You can find additional info at his website by going to www.myofascialrelease.com.  click on resources and articles.

http://www.myofascialrelease.com/fascia_massage/articles/therapeutic_insight_6.pdf

After reviewing the information please let me know if you have any additional questions.

Keep us posted,

Amy
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Hi there,

I'm so sorry to hear of the difficulties that you are facing right now following your baby's birth.

Naturally, until you have seen the specialist, it is impossible to say firstly what is causing your problem and, secondly, why it is there.

You have been given excellent advice already through the forum but I would just like to add that, no matter what is going on, you need to maintain your Kegel exercises in order to optimise your chances of recovery and to prevent additional problems ocurring.

Please do let us know how you get on.

Tracey
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1128665 tn?1269277071
Welcome to the Urogynecology community, so happy to see you both here! I am so delighted to see the interplay of advice among members. You both have great insights to provide as well as FrancoiseS; every piece of insight provided from one member to another helps clarify individual situations. The inclusion of article links is also hugely appreciated.
Sher
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I am 5 weeks postpartum and I am having the same severe stress incontinence. Neither my OB or urologist can explain why I have no bladder sensation/control... have you found relief or an answer yet?
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1128665 tn?1269277071
Will get back to you shortly!
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1128665 tn?1269277071
Hi Linds1183, welcome to the Urogynecology community!

Did you have a forceps delivery or other complications when your baby was born? Large birth weight, forceps, breech, large head can all cause complications. I assume your urologist performed tests to find out what damage occured during the delivery, but if you aren't getting any resolution, I'd recommend you seek a urogynecologist. There are so many intricate aspects to the pelvic cavity, it is much more complicated than just the bladder/urethra aspects, there are structural components that come into play as well. A urogyn will be able to assess everything within the pelvic cavity not just the urinary system. In the meantime, has anyone suggested any type of physical therapy or treatment options for you? You should at the very least be referred to a therapist who can perform tests and treatments.

Good luck, I hope you find answers soon!
Sher
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Hi,
Hoping that by this time your problem has been corrected. What you mentioned here is very similar to what happened to a very loved member of our family. She underwent aprox. two and a half hours of labor. Her Foley catheter was placed between the right leg and her abdomen. The nurse did not allow her to use the stirrups. When it was time for her to push the nurse would tell her to press her legs against her abdomen, thus yanking the Foley catheter causing hematuria (considerable amount of blood observed through the catheter tube) that was clearly seen through the urimeter. Immediately after she gave birth she experienced a similar episode to yours. She was completely incontinent. The worst part of this story is that she was given the same diagnosis that was given to you (severe stress incontinence) Nothing about a trauma caused by the yanking of the catheter against the neck of the bladder and deviating the urethra. It is time that the truth about the tremendous danger of forcing the woman's legs back against her abdomen causing the catheter to be yanked pushing with the catheter inside the bladder while giving birth. And yes, if you are pushing with the catheter inside your bladder while giving birth and your leg is being pressed against your abdoment it can cause the catheter to be pulled down into the urethra, and to strech the sphincter out of its normal function. This information shoud be tought by the OBGYN and  or medical staff to their patients before they go into labor. Please let me know if you know of any other woman that suffered the same atrocity. We need to change the culture of the negligence in the hospital setting. By the way, she still suffers from post traumatic distress. And, yes, she is still incontinent due to the trauma caused by the catheter being left in her bladder while pushing. She still has no feeling of urge because the nerves in the detrussor muscle inside the bladder are damaged. Otherwise, she only knows when her bladder is full when the her urethra hurts (not when her bladder hurts). This may be your story, or the story of many other women out there. Please help me stop this bad culture! And, plese let me know how you are doing today. =)
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Hi,
Hoping that by this time your problem has been corrected. What you mentioned here is very similar to what happened to a very loved member of our family. She underwent aprox. two and a half hours of labor. Her Foley catheter was placed between the right leg and her abdomen. The nurse did not allow her to use the stirrups. When it was time for her to push the nurse would tell her to press her legs against her abdomen, thus yanking the Foley catheter causing hematuria (considerable amount of blood observed through the catheter tube) that was clearly seen through the urimeter. Immediately after she gave birth she experienced a similar episode to yours. She was completely incontinent. The worst part of this story is that she was given the same diagnosis that was given to you (severe stress incontinence) Nothing about a trauma caused by the yanking of the catheter against the neck of the bladder and deviating the urethra. It is time that the truth about the tremendous danger of forcing the woman's legs back against her abdomen causing the catheter to be yanked pushing with the catheter inside the bladder while giving birth. And yes, if you are pushing with the catheter inside your bladder while giving birth and your leg is being pressed against your abdomen it can cause the catheter to be pulled down into the urethra, and to stretch the sphincter out of its normal function. This information should be thought by the OBGYN and  or medical staff to their patients before they go into labor. Please let me know if you know of any other woman that suffered the same atrocity. We need to change the culture of the negligence in the hospital setting. By the way, she still suffers from posttraumatic distress. And, yes, she is still incontinent due to the trauma caused by the catheter being left in her bladder while pushing. She still has no feeling of urge because the nerves in the detrusor muscle inside the bladder are damaged. Otherwise, she only knows when her bladder is full when the her urethra hurts (not when her bladder hurts). This may be your story, or the story of many other women out there. Please help me stop this bad culture! And, please let me know how you are doing today. =)
THIS IS THE CORRECTED VERSION
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I am sorry a member of your family has had such a bad experience and hope she is able to improve somehow.  
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Hi ejh1979

I hope you are well and that your problems have improved. I am writing because the same thing happened to me. I was allowed to push with the catheter balloon still inflated, and pushed the whole thing out, covered in blood, before my baby was delivered.
Nearly 2 years later I still have severe stress incontinence and been diagnosed with urethral incompetence - meaning my urethra doesn't close anymore. I've had bulking injections and while they helped a bit I still leak multiple times a day.
I don't believe that this could be just due to the birth of a normal sized baby, during an otherwise normal delivery.
Did you have any luck with your Uro-gynae, and did you end up having surgery?
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The same thing happened to me I'm wondering if it got better or if you needed surgery ?
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Same thing happened to me. Foley catheter bubble flew out my urethra when I delivered bub accidentally by vomiting prior to pushing. Foley bubble flew out with such force, it grased my inner labia quite severely, I was only 17. There was no mention of anything a miss except an incontinence nurse brought me a pelvic floor pamphlet and a free pack of incontience pads before I was discharged. I regained continence over time, but leaked if I vomited or jumped/sneezed with a full bladder.  Fast forward 10 years and I'd successfully birthed 2 more babies. At my 6 week postpartum check, my gp said I needed to see urogynae for my incontinence (which didn't bother me, he questioned me about it without me ever bring it up). Within a month I was in receiving a monarc subfacial sling. It improved nothing. Fast forward another 5 years and I'm a wreck. The sling is too tight causing my urethra to kink, reduced urine flow, urine retention, constant stinging and burning and severe urge incontinence. No doctors will listen, help or anything. The referral and reports made by gp and surgeon state I have severe Sui. I didn't. But now my life is a mess. I can barely function. I'm yet to find relief of any kind. I'm only 32 and I don't live, I barely survive.
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Have you been back to the surgeon who put this sling in for you?  
You need to find out exactly what is going on and if anything can be done to correct your problem including making any alteration to the sling or otherwise remedying the situation.
It could be that there is more than one thing going on so seeing a Urogynecologist to get a present day opinion could be a good idea.  
I know I would get a second opinion.
Constant stinging and burning could be a urine infection which could be in your bladder wall and difficult to culture.   Dont accept that you are to sit and suffer.   Go back to your Dr and get referred.  
Have they suggested reducing the tension on the sling?
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